title: Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by epinephrine sprayed on the papilla.
abstract: OBJECTIVE
  Epinephrine sprayed on the papilla may reduce papillary edema and prevent acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to evaluate the effects of localized irrigation with epinephrine saline for prevention of post-ERCP pancreatitis (PEP).
  
  
  METHODS
  A total of 941 patients who were scheduled for ERCP were recruited into this study. We randomized the patients to have 20 mL of either 0.02% epinephrine or saline sprayed on the papilla after diagnostic ERCP to prevent post-ERCP pancreatitis. We recorded duct visualization, presence of pancreatic acinarization, number of injections into the pancreatic duct, total volume of contrast used, and procedure duration. The serum amylase levels were measured at 6, 24 and 48 h after ERCP. We counted the patients of PEPs and compared whether there was significant difference between the pancreatitis group and the no pancreatitis group.
  
  
  RESULTS
  A univariate analysis of the explanatory variables between the epinephrine and control groups, the pancreatitis and no pancreatitis groups revealed the treatment to be effective, but most of the groups were not statistically significant. PEPs occurred in 40 of the 941 patients (4.25%), the incidence of pancreatitis tended to be higher in the control group (31/480, 6.45%) than in the epinephrine group (9/461, 1.95%) (P = 0.0086).
  
  
  CONCLUSIONS
  Epinephrine sprayed on the papilla may be effective to prevent PEP. Female patients (aged ≥ 18 years and < 35 years) (7/40, 17.5%), common bile duct diameter < 10 mm (27/40, 67.5%), previous cholangitis (3/40, 7.5%), body mass index ≥ 24 (22/40, 55%), and/or serum triglycerides ≥ 5.65 mmol/L (6/40, 15%), might be risk factors for post-ERCP pancreatitis, but are not statistically significant in the study.
authors.affiliation: Department of Gastroenterology, The First People's Hospital of Nantong, Jiangsu, China. xlh1118@yahoo.com.cn
authors.forename: Li Hua
authors.initials: LH
authors.lastname: Xu
authors.forename: Jun Bo
authors.initials: JB
authors.lastname: Qian
authors.forename: Liu Gen
authors.initials: LG
authors.lastname: Gu
authors.forename: Jian Wei
authors.initials: JW
authors.lastname: Qiu
authors.forename: Zhen Ming
authors.initials: ZM
authors.lastname: Ge
authors.forename: Fei
authors.initials: F
authors.lastname: Lu
authors.forename: Ya Min
authors.initials: YM
authors.lastname: Wang
authors.forename: Yu Ming
authors.initials: YM
authors.lastname: Li
authors.forename: Hua Sheng
authors.initials: HS
authors.lastname: Lu
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000187:drug effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine